HomeMy WebLinkAboutWPO201800009 Preconstruction Form WPO VSMP 2018-02-14 Request for Pre-construction Meeting and Grading Permit
from Albemarle County tzlly
Approved Plan Number: WPO- v�?/� -006109
Approved Plan Name: 02.E 7-84/4- I '/X/,? 407-5 0,79 y go,6 Lo 34 9,5 3' �35
(Plans must be approved prior to a pre-construction meeting.)
Bond approved date: qP/f y�p�O/b
(Bonds must be approved and posted prior to a pre-construction meeting or permit.)
Responsible Land Disturber:
Print Name:
State Certification Number: —72,427 0'0 :g
Address j(!6), 06X o/
City 4/9,&00777:5 G'/1 State a Zip (7?-01a
Daytime Phone(9✓y(14/a—03S7 E-mail r2/// e hQ/Q V et-ai hid/ekes,K,QfYy
Primary Contractor: J �J
Print Nametf//'� G.r]Tfe,foz $5S 2 )
Address ,g,gg A), "eit;
CityG1i.,,2O17-63 .//�2.e.- State !/// Zip 7Q/
Daytime Phone�3 4 9,Z —33Z 6,1 E-mail /OA',
Permit Issuance and First Year Maintenance Fees: (Request must include payment)
Total acres proposed to be disturbed is contained on the approved plan and application:
VSMP:
Acres to be disturbed Fee Due at Grading Permit
Less than 1 �63.80lj
I and less than 5 $594.00
5 and less than 10 $748.00
10 and less than 50 $990.00
50 and less than 100 $1,342.00
100 and more $2,112.00
For plans exempt from VSMP,VESCP fees were paid with the application.
7/1/14,Revised: 8/29/14 Page 1 of 3
Person(s)to attend the Pre-construction Meeting:
Names(type or print) Firm Contact Number or email
fJJLL Z,e / 62/51/1 7-/ /°A551_A)/. y3y�y�-a ft
The second part of the application fee is required to be paid with this request. This fee amount is;
FOR OFFICE USE ONLY Permit Issued Date
By who?
7/1/14,Revised: 8/29/14 Page 2 of 3